HEALTH INFORMATION

Circumcision

Topic Overview

What is circumcision?

Male circumcision is a
surgery to remove the foreskin, a fold of skin that covers and protects the
rounded tip of the penis. The foreskin provides sensation and lubrication for
the penis. After the foreskin is removed, it can't be put back on again. See a picture of the
penis before and after circumcision.

If circumcision is done, it's usually done soon
after birth. In the United States, about 60
out of 100 boys are circumcised, and about 40 out of 100 are not.1 Worldwide, the rate of circumcision is much lower. Circumcision has both risks and benefits. The decision about whether to have a baby circumcised is often based on the personal preference of the parents.

Some older boys and men need circumcision to treat problems with the foreskin of the penis (such as
phimosis or
paraphimosis) or for swelling of the tip of the penis
(balanitis).

This topic focuses on the circumcision of newborns.

How will you know if circumcision is right for your son?

It's up to you whether you have your baby circumcised or keep your son's penis natural. The American Academy of Pediatrics says the health benefits of circumcision outweigh the risks of the surgery. They also say that parents should be the ones to decide what is in the best interest of their child.2 When you make this
decision, it may help you to think about your personal and cultural
preferences. For example, you may want to consider your religious and family
traditions while you weigh the pros and cons of the surgery.

Circumcision is not just done in newborns. Keep in mind that your son can decide on his own later in life if he wants a circumcised penis.

What problems can occur if your son is circumcised?

Problems from circumcision are not common. If they occur, they are
usually minor. The most common circumcision problems are:

More serious problems are rare. They include damage to the
opening of the urethra, heavy bleeding that requires stitches, severe
infection, and scarring.

Who performs circumcisions?

Circumcisions usually are done by a
pediatrician,
obstetrician,
family medicine doctor,
surgeon, or
urologist. Circumcisions that are performed for
religious reasons are sometimes done by others trained in the procedure. For your baby's safety, it is best that the person doing the surgery is well trained, uses sterile techniques, and knows how to manage your baby's pain during and after the surgery.

What Happens During a Circumcision

Circumcision is usually done by a doctor at a clinic,
in the hospital, or at an outpatient surgery center. During the
procedure:

The baby is placed on a firm surface. Velcro
straps are wrapped around the baby's arms and legs to keep him very
still.

The penis is cleaned.

The surgical area is often numbed with a
local anesthetic while the baby stays awake.
If your baby is age 1 month or older, he or she may need general anesthesia. Talk with your doctor about the best way to control pain in your child.

A sterile circumcision clamp or device is
placed over the head of the penis. The three most common types of clamps used
are the
Gomco clamp, the
Mogen clamp, and the
Plastibell device. Each clamp has pros and cons,
although differences between the clamps are often minor. Most doctors use the
clamp they are most comfortable with.

The foreskin is removed using a sterile scalpel or
scissors.

What to Expect After Surgery

After the
circumcision, the groin, penis, and scrotum may appear
reddish brown because of the liquid used to clean the skin before surgery. The
shaft of the penis where the skin was removed will look raw and slightly
swollen.

Your baby will stay in the hospital or clinic for 2 to 4 hours
after the procedure. His penis will be checked for bleeding, and the
circumcision area may be covered with petroleum jelly and gauze.

You will likely take your baby home
the same day he is circumcised. Some swelling around the penis is normal in the
first few days after the surgery. Some slight bleeding may occur. If this
happens, apply direct but gentle pressure to the area with a clean cloth or
bandage for about 5 to 10 minutes.

After surgery, your baby will
feel some pain. He may be fussy and have trouble sleeping.

If gauze was
used, it will probably come off when your baby urinates. Follow your doctor's directions about whether to put clean gauze on your baby's penis or to leave gauze off. If you need to remove gauze from the penis, use warm water to soak the gauze and gently loosen it.

A thin
yellow film will form over the circumcision site after surgery. This is part of
the normal healing process and should go away in a few days. Although the penis
is beginning to heal, it may look worse a few days after circumcision. The
penis should look like it's getting better about a week after surgery.

Care after surgery

Here are some things you can do
to help your baby feel more comfortable:

Gently wash the penis with warm water after
each diaper change. Don't use soap. Pat dry.

Put petroleum jelly,
such as Vaseline, on the circumcised area. Petroleum jelly keeps the scab from
sticking to the diaper.

Make sure diapers are fastened loosely so there is less
pressure on the penis while it heals.

Don't try to remove the film that forms on the penis. It will
go away on its own.

Who to see

A urologist or surgeon normally will do circumcisions on
older infants, children, and adults.

Why It May Be Done

Some parents may make the decision about circumcision based on
religious and family traditions, personal preferences, or the social norms
of their communities. Often these cultural reasons affect the decision more than the medical risks and benefits of circumcision.

The American Academy of Pediatrics (AAP) says the health benefits of circumcision outweigh the risks of the surgery. But it's up to you whether you have your baby circumcised.2

Health benefits of circumcision include being less likely to get urinary tract infections (UTIs) or sexually transmitted infections (STIs). For example, in a
baby's first year of life,
UTIs happen less often in
circumcised boys than in boys who are not circumcised. But UTIs are not common.

There may be reasons later in life when your son may need a
circumcision. A boy or man may have problems retracting the foreskin or may
have swelling of the foreskin that requires circumcision.

Irritation of the exposed tip of
the penis (glans) as a result of contact with stool or urine.

Long-term problems can include:

Damage to the opening of the urethra, which
leads from the bladder to the tip of the penis (meatal stenosis).

Scarring of the penis from infection or surgical error. For
example:

The entire foreskin may not be removed,
leaving portions of it attached to the penis (skin bridge). This may cause pain
during erection.

Scar tissue can grow outward toward the tip of the
penis from the cut edge of the foreskin. Repeat surgery on the penis may be
required to improve appearance or to allow normal passage of urine if the
opening from the bladder has been blocked by this scar tissue.

The
outer skin layer (or layers) of the penis may be removed
accidentally.

An opening that is too small for the foreskin to
retract over the penis (phimosis) can happen if too
little foreskin is removed.

Major problems are very rare but can include:

The removal of more skin from the penis than the doctor intended.

Too much bleeding. Stitches may be needed to
stop the bleeding.

Serious, life-threatening bacterial
infection.

Partial or full removal (amputation) of the tip of the penis.
(This is extremely rare.)

What to Think About

Your values

As a parent, you will decide whether you want to keep
your son's penis natural or want him to be
circumcised. This decision often is a personal one based on your own values and religious or cultural beliefs.

It's a
good idea to think about your decision before your baby is born. If you wait,
the excitement and fatigue of the delivery can affect your ability to carefully
consider the benefits and risks of each choice.

Your son's values

Circumcision is not just done in newborns. Keep in mind that your son can
decide on his own later in life if he wants a circumcised penis.

Circumcision and STIs

Some studies have shown that circumcised men are a little
less likely than men who have not been circumcised to get or spread a
sexually transmitted infection (STI), including
HIV.

Any man, especially if he has
high-risk sex, can get STIs, including HIV. The best way to
prevent STIs is to teach people about risk factors and the importance of
avoiding high-risk sex.

Other concerns

Keeping your son's penis clean may
help prevent infection and other problems. It's important to keep your son's
penis clean whether he has been circumcised or not. When
cleaning a natural (uncircumcised) penis, be careful
not to force the foreskin to retract.

If you decide that you would like to
have your baby circumcised, talk with your doctor about concerns you may
have about pain and your preferences for
anesthesia. Ask your doctor about giving your baby
acetaminophen (such as Tylenol) for pain relief after
surgery.

When is circumcision not done?

Your doctor may not do circumcision if your baby has a medical
condition that makes him more likely to have problems from the surgery, such
as:

Your baby is sick or unstable (such as not
eating well, having trouble passing urine or stool, or having a hard time
maintaining his body temperature).

Your baby has an abnormality of
the penis, such as having the opening of the
urethra on the side of the penis shaft instead of on
the tip of his penis (hypospadias or epispadias). Your baby may need to have an
intact foreskin so that this problem can be fixed with surgery when he is
older.

Your baby has swelling or protrusion of the spinal cord
(myelomeningocele or
spina bifida).

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use.
How this information was developed to help you make better health decisions.